" State if the Art " eyedrops (Asia)

[aquaman]

First, a little bit about me.
I had Lasik about 13 years ago and never had dry eyes after the surgery, however recently, after dissecting a corpse (I'm in the medical profession), I was exposed to formaldehyde fumes and my right eye became red and dry, while my left eye remains ok. I've been having severe dry eye for a few months, apparently the damage caused is permanent. My score is 3mm for the right eye and 15mm for the left.

I live in China, Japan and HK, here in Asia the treatment options for KS are somewhat different from the U.S. Since Restasis hasn't been approved as it has been failing in providing improvement over control groups, the first line of treatment remains unpreserved artificial tears. Now here is where things start to get interesting...

The top clinics for dry eye treatment (also a common post-Lasik outcome here) are prescribing Santen's "Diquas", which acts on purine receptors to stimulate both mucin and tear production. Santen found the 3% solution superior to the 2% tested in the U.S a while ago, and began to market it.

Another line of treatment, which again differs from Autologos Serum preparations, due to certain skepticism here (and maybe practicality), is the use of Bovine Serum eyedrops (bFGF), a recombinant fibroblast growth factor matrix in the high order of 21.000 IU per bottle. Its main use was the healing period of refractive surgery, however new studies also pointed out its efficacy in treating DES. There are plenty of controlled studies already indicating good outcomes in several pathologies like recurrent corneal erosions as well.

For those diagnosed with meibomian issues and mucin deficiency, there is a specific drop that targets lipid pathways: Rebamipide 2% (Mucosta) also from the land of the rising sun, and not often prescribed in China.

A final modality is the use of bacterial eyedrops, yes you've read it correctly, probiotic drops to tackle dry eye. Studies are showing high efficacy not only in dry eye but also Vernal Conjunctivitis and a few other conditions. Actually, it seems Dr Latkani himself is aware of the treatment: http://www.eyeworld.org/article.php?sid=4964 . Funny enough, there is a growing dry eye community here in China that can't live without the drop...


As for myself, after using artificial tears without borate or BAK for a while, and failing to observe improvements on inflammation on FML + Patenol, I've had my first breakthrough with the bovine recombinant serum drops and recently have been having awesome results with the probiotic eyedrops, i.e, my corneas have stopped getting stuck to the eyelids in the morning, even when I don't use any eyedrops, and my daily comfort has increased a lot.
As for the Diquas and Mucosta, I've tried both, Diquas is indeed highly effective over, say, regular tears; while Mucosta didn't help much, maybe because I have no issues with mucus production/meibomian glands. I feel as if the probiotic drops and the bovine drops have given me back my functionality after a few months of hell. I knew the bovine drops were going to work when I started noticing my right eye become whitee after months of redness. Furthermore then probiotics have the same effect as the bovine drops, they make your eyes pearly white.
Actually both drops seem to have a great staying power as they give me around 6-8 hours of lubrication dispensing the need for artificial tears. With the probiotic eyedrops it's actually funny to observe the eyes making a lot of mucus near the tear ducts.

I also tried Omega-3's Acetylcysteine and Doxy but have not responded at all. Creatine on the other hand (15 g/day) has been VERY helpful. My next steps will be to get my upper and lowers cauterized (I won't even bother with plugs) and a short injected anabolic steroid cycle to gauge my tear production response. I also will get a Sjogren serology as I've been noticing dry mouth lately, as well. Restasis or Sclerals, might be an option if all fails, however I'll opt for the 0,2% optimmune veterinary prep instead. Sclerals, won't be bad as I have my share of Starbursts and Halos since my dumb refractive surgeon chose to operate me despite my 10mm pupils.

I have links to all the studies mentioned above and will post them shortly below, as I've been quite busy recently.
-Aqua.

[AndyLynne]

Hey Aquaman,

Thanks so much for your post providing information about dry eye treatments in Asia. It seems you're very knowledgeable regarding new treatments. I'm sorry to hear that you have this problem but I want to say good on you for researching all your options and sharing this information with other dry eye sufferers! I'm approaching the two year mark with dry eye. It's been a nightmare. Once I got my eyes to the point where I could use a computer again (albeit limited use), I did plenty of research over many months about treatment options. Bovine serum drops and probiotic drops are news to me so thanks for this.

I am interested in your post because I am planning to travel to China in order to try treatments that might work for me. I'm currently in New Zealand. Primarily I want to try Mucosta because I believe I have a mucin problem due to issues with other mucosal producing parts of my body - nose, stomach, intestines. Also, my eyes are so much better when I have a cold which I've read is due to increased mucin production. Also, I can see a pooling of tears at the bottom of my eyes and I've read mucin helps distribute the tears evenly over the eye by holding the water onto the eye surface. I also have MGD. I expressed them myself to find out (using a mastrota paddle - ophthalmologists would not provide information so I had to do it myself) and I couldn't see any oil, just toothpaste-like stuff. I also have some aqueous deficiency but it's hard to know what is the main problem and what is causing what. A common problem for dry eye sufferers.

I have been VERY disappointed by the "care" I have received from opticians, ophthalmologists and GPs in the west. They were all very dismissive of dry eye disease. One ophthalmologist was quite literally silent when I asked him questions. He just ignored me. He also laughed when I told him how I was going to suffer with the drops and tests he did on my eyes. My GP told me dry eyes are "only a nuisance", looking at me like I was some kind of idiot as I cried, struggling with the fact that dry eye has destroyed my life.

I think the treatment options here in the west are way too limited too. So, I'm thinking of heading to China. Luckily I have a friend in Shanghai who is sympathetic to my problem. She's looking to arrange an apartment for me and I will start with Mucosta. She has bought it online for me but unfortunately she can't get it through Chinese customs to send it to me. I'm scared about travelling and staying in an unknown apartment because my eyes are so dry and sensitive to the environment, but I am desperate now. I have to do something.

Diquas may be an option too but I am reluctant to use drops with BAK. When my dry eye first developed the optician I saw gave me lubricating drops with BAK which I used for several weeks, maybe a month - my eyes getting worse and worse. I wonder now if she had given me preservative free drops whether it would have escalated to the point it has.

Anyway, I know that dry eye is more prevalent in Asia which is probably why they have more options. I'm very interested in the probiotic drops. I wonder what the mechanism is that makes them work. How could I go about getting these in China, do you know? It may be another option for me.

Thanks so much!

Andy.

[Guest]

Thanks so much for posting about these treatment options. I'd never heard of them before, so it caught my interest!

[patrick]

Immediately caught my attention to!
Thanks for posting aquaman. Hopefully you keep us updated here on the forums about the developments in asia.
Sure sounds interesting.

Patrick..

[bakunin]

Yes, thank you very much! Many products I never heard before.

My onset was 6 after Lasik. In my case what triggered my (severe) dry eyes was an AC in my workplace, powerfull and straight to my eyes for six months.

[spmcc]

Aquaman, I love your post. Please keep them coming!

I looked into getting Diquafosol compounded (active ingredient tetrasodium salts). The compounding pharmacy (Leiter's in San Jose, CA) wrote:

Unfortunately we have not been able to find a FDA approved supplier for this chemical. Thus we will not be able to compound this at this time.

AndyLynne, Please let us know how things go. You're doing what I want to do... working on goblet cells. How do you plan to use/take Mucosta? Orally or topically?

[aquaman]

Andy, if you need, I can refer you to a good dry eye hospital in Shanghai.

If you do come, I'd also advise you to make a quick trip to Beijing, you can get there in about 6 hours by bullet train from Shanghai, so you don't need to plan in advance. In Beijing there is a hospital that does a procedure called Salivary Gland Transplantation for the dry eye syndrome.

I don't know how severe is your case, but in my case, I'm hovering around 0 mm's on my right eye and as soon as I rule out Sjogren's, I'll get it done. I was reading a study and the prognosis for 3+++ years is excellent, it has given many people their life back.

They've actually been performing this for almost a decade but word hasn't come out much. Except for criticism from a certain a western doctor saying that salivary glands don't make "natural" tears, well, for one he wasn't familiar at all with the surgery, and second who cares if the tears are the exact same composition or not. The salivary gland "tear" quality is indeed very good, abundant and they come with an excellent break up time, as it naturally does have a bit of lipids in it. I mean, all that we want is our 20 mm's back and "natural" does not seem to be an issue, as the eyedrops he prescribes aren't "natural" either...

[aquaman]

For those of you in Europe: http://www.peter-raus.be/dry_eyes.html


Surgical treatment for dry eyes

Prof. Juan Murube, from the famous Alcalá University of Madrid in Spain, discovered that the secretion of the salivary glands from the lower lip is very similar to natural tears, and has developed a surgical technique to transplant the glands to the inner side of the eyelids. These glands are easily accessible and can be transplanted to the eyelids together with the mucous membrane that covers them. Dr. Raus has slightly modified this technique by using radiosurgery. He also prefers to use a running suture rather than separate ones. With the patient under general anaesthesia, a specimen of labial mucous membrane of the lower lip and the underlying glands is removed and transplanted to the inner, conjunctival side of the eyelid. The patient need only stay in the hospital for one night, and the stitches can be removed after two weeks.
What results can I expect?
When the stitches are removed, most patients notice an immediate improvement, and are able to reduce artificial tear treatment.
To check this new surgical procedure, Dr. Raus asked a pathologist to microscopically examine the transplanted glands. Tissue examined after 18 months and 36 months, confirmed that the transplanted glands were performing as normal. Furtheremore, there was strong evidence that the new secretions not only lubricated the eye, but also stimulated the lacrimal glands in the eye, enabling patients to secrete more natural tears.
Although more studies needs to be done on this type of surgery, Dr. Raus’ technique of transplanting the labial salivary glands promises to be an excellent alternative for cases when conventional treatments for very dry eyes fail. Patients recover quickly with only minimal discomfort. However, this treatment is not the first choice of treament for dry eyes, and should only be considered in the most severe cases.

[aquaman]

Studies confirming efficacy of Bovine Serum Drops: http://www.ncbi.nlm.nih.gov/pubmed/21418923

Andy, the Probiotic drops are based on the lactobacillus strands and contain no preservatives. All drops can be sent away from China without being confiscated by customs, advise your friend to try a different postal company.

To all, I'm glad to help, sorry for the typos on the first post and taking so long to reply, but I literally have a busy doctor's schedule.

[AndyLynne]

Aquaman, thanks for the information. Very useful, I will keep it in mind. Thanks for being helpful, while being busy and having such a bad case of dry eye at the same time. I'm impressed.

Spmcc, the product I want to use is taken topically. It's the same one as in Aquaman's jpeg. Here's some info: http://www.rad-ar.or.jp/siori/english/kekka.cgi?n=32404
I've read some of you're other posts and see you have problems with eye drops like I do. Every single lubricating drop I've tried (and I've tried many) provide temporary relief but then make my eyes worse. I have facial rosacea and very sensitive skin, I guess it's the same with my eyes. Anyway, If I manage to get to China to try it out I'll definitely let you know how I get on with it. I'm in a bad place psychologically at the moment and not coping very well. I frightened of travel because my eyes are so sensitive to everything in the environment, for example, if I end up in an apartment where fabric softener has been used previously my eyes will be screwed. Sounds crazy, but it's happened to me before.

[icycarol]

Hi! Thank you for your post ! I live in Taiwan and struggle with my dry eye for a year. I went to Hk to try sclerals last week, I ordered it but still don't know if it will help.
About labial transplantation, I've heard that some people may got inflammation because the saliva is not tear at all. I don't know if this is a right information, just want people to be careful.

Carol

[spmcc]

Surgical treatment for dry eyes

For those of you in Europe: http://www.peter-raus.be/dry_eyes.html

A DEZ member (peter56) has posted a lot about the benefits of salivary gland transplantation. See one of his posts here: http://www.dryeyezone.com/talk/showt...2632#post82632

[spmcc]

Hi AndyLynne,

Spmcc, the product I want to use is taken topically. It's the same one as in Aquaman's jpeg. Here's some info: http://www.rad-ar.or.jp/siori/english/kekka.cgi?n=32404

Ah, I see. I hadn't noticed Mucosta in aquaman's post. Thanks. You know, I've been looking at drugs that cause/create mucus in other areas of the body (GI, lungs, etc.) to see if there's a way to get them for the eyes. And here one is! I'm very excited for you. I'm going to contact some compounding pharmacies to see if these can be made. The active ingredient (rebamipide) is not unknown.

I've read some of your other posts and see you have problems with eye drops like I do. Every single lubricating drop I've tried (and I've tried many) provide temporary relief but then make my eyes worse. I have facial rosacea and very sensitive skin, I guess it's the same with my eyes.

Yep, ocular rosace here too (since mid-1990s). *Everything* causes my eyes and facial skin to freak out. I completely understand about the fabric softener. I can't handle being around any scents.

Anyway, If I manage to get to China to try it out I'll definitely let you know how I get on with it. I'm in a bad place psychologically at the moment and not coping very well.

I wish you all the best. Please get a good pair of moisture chamber glasses/goggles for travel. They help especially in airports and on planes.

I'm sorry that you're not doing well right now. I hope it all turns around for you soon.

[Pinky]

http://www.sulit.com.ph/index.php/cl...otic+eye+drops

Are these the probiotic drops?

[aquaman]

About labial transplantation, I've heard that some people may got inflammation because the saliva is not tear at all. I don't know if this is a right information, just want people to be careful.

Carol

Hi Carol, where did you hear that info, from a doctor ? Yesterday, I went to cauterize my right tear duct and the doctor said that my eye wasn't bad enough for cautery. He told me that after having two Schirmer tests right there that confirmed 0mm on my right eye and 12 on my left.

I mean, if you've got 0mm how much worse does it have get to have the freaking thing? -5 ?

I told him this right in front of his assistants: -My right eye can't possibly be worse, what I really hear you saying is that you don't know how to perform this surgery.
They came around with:
-But I saw some tear pool on your lower eyelid before the schirmer, as I replied:- What you probably saw there was the leftover of an artificial tear I had applied on the taxi and oils from the meibomian glands.
I then left in disbelief.

Here in China, if you live in the South or are far from a big city, like Beijing or Shanghai, Hospitals aren't too good. Even an entire hospital dedicated to Eye Care like the one I was in. Basically, most eye hospitals here just want to make a buck with Lasik.

Actually thinking back maybe it was a good thing not having the surgery as I can probably have an salivary implant and will probably get overflow with it, so it is wise to leave cautery for last.

I am inclined to think whoever told you about inflammation with salivary implants isn't knowledgable about it. As it is my understanding, ALL inflammation in ATD dry eyes (my case) and probably other dry eye cases as well is related to hyperosmolarity of the tear film. An eye with tears+saliva would provide a good quality film.